After several months of waiting, I finally got my COVID-19 vaccination in the state of Oregon on March 19. I wrote this article to share the strengths and weaknesses of the U.S. vaccination policy and the key steps in the vaccine administration process, which Taiwan can refer to as it kicked off the vaccination on March 22.

The second wave of increased cases started in October last year and the spreading became unstoppable in late November. In a number of interviews, I reiterated my position: the failure to do everything to prevent and control the outbreak when lifting the lockdown restrictions in June made the crisis spins out of control. And the vaccines are the only hope. Oregon, for example, has a small population of 4.32 million, and the daily new cases were between 40-80 before the restrictions were lifted. I said in the interviews that the restrictions should remain intact until daily new infections were down below 20. But the state government did not take my advice. Then by November and December, the daily new cases soared to over 1,500. Out-of-control spreading was seen across the U.S.

The U.S. began administering vaccines in mid-December, 2020. Given the short supply, chaos arose around the vaccination priority lists, with more than 50 versions throughout the nation, or dozens of versions in one state, almost one version in one county. Theoretically, every single state has its priority list, but it is the county health department that is responsible for administering the vaccination plan. Most of the agencies are not capable of carrying out the unprecedented vaccination operation due to a shortage of funding and manpower, the result of long-time negligence of public health infrastructure. The responsibility has thus mainly or partially shifted to local hospitals or medical institutions.

A serious problem of vaccine inequality is reported. Since there is no unified national health care system, nor a unified state health care system, it is impossible to get residents’ health registration records. Therefore, it is up to every resident to go online and register for the shot. After their status is checked and verified, they have to wait for the health staff to contact and tell them by email when to get the jab. Eligible individuals will schedule their vaccination date and time online. This practice is a big challenge for the elderly who don’t know how to use a computer and the Internet.

Two vaccines are available, Pfizer/ BionN Tech and Moderna, both of which require deep freezing. Almost no vaccination sites have an ultra-cold freezer. That’s why the daily doses have to be estimated in advance and delivered to the site in the ultra-cold freezers from county health departments or major hospitals. When people do not show up to vaccine appointments, their vaccines will expire. The problem happens at a number of vaccination sites: the extra vaccines have to be discarded if they are not administered within a set amount of time. Some who have time and are able to reach the site are waiting outside around closing time in the hope of receiving a leftover dose. Some health workers and volunteers who assist at the site will contact their friends and family to get a shot at short notice. And in many places, unused vaccines are discarded.

The problem has drawn attacks from medical and ethics experts, saying it is unfair to low- and middle-income people who have trouble finding time, accessing real-time information, and setting out for the site at any time. The problem has also led to dual systems for priority lists: state-level regulations and county-level practices are at odds. Many of my colleagues who are pushing for health coverage for all have criticized this as inevitable due to the lack of a universal health care system.

U.S. vaccine supply was short. The vaccination time scheduled by the state for those on the priority list and for different age groups was severely delayed. The vaccination finally started to speed up after President Biden’s COVID relief bill was passed. My county, for example, had vaccinated 400-600 per week before the bill was approved, and the number significantly increased to 4,000 two weeks ago.

The vaccination process is quite confusing and chaotic given the lack of a unified national booking system. It took me two weeks and four times to book the vaccination appointment before I received a booking confirmation by email. I found the email was sent last week, but it was put in the spam folder by the email system. The letter appeared suspicious as I found the sender was Gmail instead of the county health department. Since we saw a number of scam emails and fake phone calls claiming to be from the county health department, I gave a copy of my confirmation email to one of my students who is the head of infectious diseases of the county’s health department. She emailed me back quickly. (I tried to make a call but it was extremely difficult to get through.) She said the email was not a scam, explaining her office commissioned a local hospital to handle the service.

I told her the email had two standard features of a scam: the sender is from an address that ends with @gmail.com; ask the recipient to enter his social security number, which is not required to book a vaccination appointment. She told me I did not need to enter the number. She also changed the sender’s email address to the county health department. I wonder how many people, like me, had ignored the notice by thinking it was a scam, and delaying or missing the jab.

The vaccine administration is working in an orderly manner. My wife and I arrived at the vaccination site (Oregon State University’s football stadium) 20 minutes before the appointment time. The steps include: first, check the status to confirm the appointment; second, go into the stadium and answer seven questions on the screening list. If you answer “yes” to any questions, you will be asked additional questions. If not, you will go to the next step. Third, go to the counter to register your personal information and get a CDC COVID-19 vaccination record card containing your name and date of birth.

Fourth, get a jab at one of the stands. And you can’t choose which vaccine you get. I got Pfizer and the nurse put a small sticker on the vaccine card which contains the name of the vaccine and its serial number. And a sticker was placed on the shirt with the time to leave the post-vaccination observation area. Fifth, after vaccination, wait in the observation area for 15 minutes to make sure no allergic reactions. The seats were two meters apart, and staff will disinfect the chairs immediately after they are used. Sixth, make an appointment for the second dose, three weeks apart for Pfizer and four weeks apart for Moderna. It takes about 50 minutes to complete the vaccination.

In the U.S., hard-hit by the pandemic, I feel a lot relieved after the shot, which is quite hard for many in Taiwan to imagine. I have not seen any students, colleagues, most of my friends in person for a whole year. Now, my students are looking forward to meeting me personally after my second dose.

(Chi Chun-Hui: Director of the Center for Global Health and Professor of Global Health at Oregon State University, Visiting Professor of Global Health and Development Program at Taipei Medical University)

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